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Dr. Luis Macias is an En Bloc Explant Expert and very experienced with patients that have explant questions or concerns. Breast implant-associated anaplastic large cell lymphoma (or BIA – ALCL) is a very rare cancer condition affecting a percentage of women with textured-surface implants. ALCL is a form of immune system cancer, not breast cancer, and can typically be fully resolved by surgical removal of the implant and the scar tissue capsule that surrounds it. The likelihood of having ALCL is less than the likelihood of becoming a lightning victim. In the U.S. in any one year 1 in 700,000 are likely to become a lightning victim and the odds of being struck in your lifetime is 1 in 3,000.

What is ALCL?

In July 2019, the FDA updated information as to the number of ALCL reports, and this is now reported as 573 unique and confirmed BIA-ALCL cases worldwide. The time from implant placement varied from patient to patient, with the large majority of cases impacting women with either silicone or saline textured-surface implants. ALCL is what is termed a “T-cell lymphoma,” a cancer affecting immune system cells.

How serious is ALCL?

The development of any cancer is serious. However, this form of cancer is highly-treatable, and currently affects one patient out of 30,000, a rare occurrence. The fact that the condition can typically be completely resolved with the help of board-certified plastic surgeon, Dr. Luis Macias, should help bring you peace of mind if you are experiencing any symptoms, or are concerned that you may develop the condition in the future.

What are the symptoms of ALCL?

The symptoms vary from woman to woman, but most commonly include:

  • Breast enlargement
  • Pain
  • Asymmetry
  • Lump forming in breast or armpit
  • Skin rashes
  • Hardened breast,
  • Fluid collection around implant

Do all breast implants have the risk of causing ALCL?

The risk of developing ALCL is related strictly to women with textured implants, with no occurrences affecting women with smooth-surface implants. ALCL has developed in women with either silicone or saline implants with a textured surface.

If I have textured Implants, should I have them replaced or removed?

Some women with textured implants have concerns about the possibility of developing ALCL and are considering having the implants removed and replaced. Dr. Luis Macias is an Explant Expert that understands patient concerns to remove or replace implants. With the condition affecting only one in every 30,000 women, the likelihood of developing the disease is very low. Nonetheless, you may be one of the many women who wants to avoid the risk of developing ALCL in the future and elect to have your breast implants replaced with smooth versions.

How is BIA – ALCL treated?

After a diagnosis, depending upon how far the disease has advanced, various treatments may be required. The condition is diagnosed by an oncologist, or cancer specialist to determine the stage of the disease. When the condition is limited to the area around the implants, surgery can be performed to remove the implant, along with the scar tissue capsule that has developed around it. For more serious cases, cancer treatment is required. Thankfully, most cases are identified early, due to visible or painful symptoms, or both.

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Does Dr. Macias provide treatment for BIA – ALCL?

Dr. Macias is an En Bloc Explant Expert and provides treatment in cases that require only breast implant and scar tissue removal to resolve the disease, but he does not offer chemotherapy or radiation therapy for advanced cases.

Is there any way to prevent ALCL?

To avoid developing ALCL, some women are choosing to take the step to replace textured silicone or saline implants. As the disease, to date, has only occurred with textured implants, removing and replacing them should resolve any risk. If you have textured implants but have no symptoms of ALCL, it does not mean you must have your implants replaced. If your breast implants are older, they will at some point, require replacement, and you may choose to have that procedure sooner rather than later.

Why should I choose Aesthetic MdR?

To replace textured implants to ward off the risk of developing ALCL, or to resolve the condition when it is limited to around the implant, you want your surgery to be performed by a top-rated, board-certified plastic surgeon. Dr. Macias has achieved acclaim for his outstanding surgical work, including being named “Top Plastic Surgeon” by Super Doctors and RealSelf. You can be confident your breast implant replacement surgery, whether after augmentation or reconstruction, will be performed carefully, correctly, and achieve beautiful results.

Should I be tested for ALCL?

If you have concerns about developing ALCL, you can be tested. There are no current screenings for the disease that are standardly administered. However, testing can be performed if you are experiencing any symptoms or have general concerns that you may develop the condition in the future. The testing involves extracting a small portion of fluid that has developed around the implant and tested by an oncologist. If you are not experiencing any symptoms, the FDA does not advise you to have your implants removed, although you always have that option.

Who is at higher risk for developing ALCL?

While the development of the disease cannot be predicted, there are some contributing factors that have been identified, including:

  • You have textured implants: There are no reports of the conditions developing in women with smooth surface implants.
  • Genetic predisposition: There may be a genetic connection, but this is still being studied. Two published reports indicate that genetics may play a role in developing the disease.
  • Inflammation: It is believed that chronic inflammation, which may be triggered by an allergic response to the implant, bacteria, or other factor could be a contributing factor in developing ALCL.

What causes ALCL?

This is currently being studied, with data suggesting that issues such as bacterial contamination, allergic inflammation or ongoing tissue irritation related to the implant texture are all theories under investigation.

Are textured implants still FDA-approved?

Currently, it is considered that the risk of developing the disease is low, with no need to discourage women from having textured implants. However, it should be noted that in some countries, these implants have been banned as a precautionary measure. If you are considering breast augmentation, it is advised that you choose smooth surface implants rather than textured.

What is the procedure?

To replace implants requires incisions, placed in the same location as the original surgery. The breast implant, along with any scar tissue, is then surgically removed, and new smooth implants put in place. The incisions are carefully sutured. The recovery time is generally a little shorter than the original surgery, but every person heals at a slightly different rate. Generally, expect to take a week to ten days off work to rest and recover.


Dr. Luis Macias

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